The straight dope on Italian health and medical care, from an American woman doctor who lives and works in Rome. Her memoir, Dottoressa, will be published in May 2019.

Thursday, February 14, 2019

Pack 'Em In

Lecture Hall at an Italian Medical School, 2014

When I first moved to Italy, any high school graduate who thought
they might like to be a doctor had the right to give medical school a whirl.
Because of this open admissions policy, ten times more physicians were churned
out each year than the country needed. And because there was no way those
hordes of students could get individual attention from their teachers, and far
too few bodies for them to learn on, you could graduate from med school without
having ever touched a patient. Literally. Italian medical training was so
notorious that when the European Union started recognizing degrees and
specializations across borders, Italy risked being the only country excluded.

The threat of that humiliation goaded Italy to begin a minor
revolution. By the turn of the century a system of selection for medical school
had been introduced (based on a multiple-choice test), freshman classes had
been slashed by 90%, and students were starting to be taught at patient bedsides
instead of only from books. Italian medical training was making giant strides
toward joining the rest of Europe.

Now, twenty years after Italian doctors began their Long March from
laughingstocks to world-class clinicians, the Italian Health Minister, Giulia
Grillo—a physician previously known mainly for waffling on the need for
vaccination—has been crusading to turn back the clock by bringing
back open admissions for medical school.
No more tests. No more selection process. Anybody who made it through high
school would again be welcome. Come one, come all!

Dr. Grillo, from the Five-Star Movement, has even added a sour cherry on top: the downgrading
of postgraduate training. She points out, correctly, that due to sloppy
planning Italy has gone from too many prospective General Practitioners to too
few, and trains far too few specialists in emergency medicine to keep hospital
Emergency Rooms properly staffed. Her proposed solution? Stop requiring docs hired
for those jobs to have any residency training. Instead, she says, hospitals
should be able to employ anybody with experience, such as night coverage
(Guardia Medica) on the National Health Service, assuming they’ll have picked
up their trade by osmosis. Even worse, she’s suggested maybe those ER docs and
GPs could be hired fresh out of medical school. Anywhere in the world that
would be a mistake, given the complexity of modern medicine, but in Italy—where
medical school is still relatively weak on the practical—it would be madness.

Already many young Italian medical graduates flee the country, headed
for nations where they expect superior specialty training, higher stipends, and
eventually a better chance at real jobs. And already Italian specialty training
is uneven, turning out specialists whose levels of competence range from superb
to iffy. If even that spotty training is turned into an optional, with
self-taught doctors handling heart attacks and accident victims . . . poor
Italy!

Pardon my rant. I’ve never been good at buddhistic acceptance,
and the coronation of Donald Trump reset my indignation threshhold even lower.
By now even a considerably less dangerous Italian Minister of Health can
trigger it.

P. S. The picture of a medical school lecture hall at the top of
this post was from 2014, when the admission process was highly selective. Imagine
how packed those halls used to be when ten times as many students were
enrolled, and how they will be again if Dr. Grillo gets her way.

About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.